Provider Demographics
NPI:1083798334
Name:BAJPAI, RAVI K (DO)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:K
Last Name:BAJPAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24639 N 45TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-3046
Mailing Address - Country:US
Mailing Address - Phone:623-587-0973
Mailing Address - Fax:
Practice Address - Street 1:14973 W BELL RD
Practice Address - Street 2:#100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3202
Practice Address - Country:US
Practice Address - Phone:623-815-2900
Practice Address - Fax:623-583-1319
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4535207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ154679Medicaid
AZ112028Medicare PIN
AZ154679Medicaid